COMPLICATED APPENDICITIS WITH ATYPICAL PRESENTATION IN AN ELDERLY PATIENT: RELEVANCE OF ULTRASOUND FINDINGS FOR EARLY DIAGNOSIS paolomerino@hotmail.com

 

COMPLICATED APPENDICITIS WITH ATYPICAL PRESENTATION IN AN ELDERLY PATIENT: RELEVANCE OF ULTRASOUND FINDINGS FOR EARLY DIAGNOSIS

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Spain

Poster Exhibition only

Acute appendicitis in elderly patients poses a diagnostic challenge due to frequently attenuated symptoms and the presence of comorbidities, often leading to delayed diagnosis and increased risk of complications. Despite its limitations, abdominal ultrasound remains an accessible and valuable diagnostic tool in this population.

A 73-year-old male presented with abdominal pain of 3–4 days’ duration, initially located in the lumbar region and later radiating to the hypogastrium and right iliac fossa. He reported no fever, nausea, or vomiting. Physical examination revealed localized tenderness in the right lower quadrant and right flank, with rebound and guarding. Laboratory tests showed leukocytosis (20,960/μL) with 91% neutrophils and elevated C-reactive protein (230 mg/L). Abdominal ultrasound revealed a dilated, hypoechoic, and disorganized appendix, associated with a pericecal fluid collection, inflamed periapendicular fat, and a suspected fistulous tract—findings consistent with complicated appendicitis. The diagnosis was confirmed intraoperatively.

This case highlights the importance of maintaining a high index of suspicion for appendicitis in elderly patients presenting with atypical symptoms. The combination of ultrasound findings with clinical and laboratory data enabled prompt surgical intervention despite the nonspecific presentation.

Complicated appendicitis in elderly patients may present with subtle or atypical symptoms , delaying diagnosis. This case highlights the essencial role of abdominal ultrasound in guiding early diagnosis and timely surgical management when clinical signs are nonspecific. Integrating imaging with clinical and laboratory data is key to improving outcomes in this high-risk population.